Hospital/Non-Hospital Career as a Radiology

[Radiologist in Training]

IN HOSPITAL JOBS

As far as radiology goes, my understanding is that after a 5 year residency, most graduates require 1-2 fellowships to work staff positions in big city hospitals. I wanted to know if this is true. Also, I have heard of about the declining lifestyle of radiology. Traditionally, it is known to be a lifestyle "ROAD speciality." Is there the option to work as much or as hard as you want when in a hospital? Would I maintain some degree of control?

 

OUT OF HOSPITAL JOBS

I was also wondering if there are any other options for work outside of hospitals as a radiology. For example, I know Anaesthesiology has lots of opportunities to work in outside clinics. In my city, there are some radiologists that have opened outpatient clinics out of the hospitals. How common is this? And what kind of services could a radiologist provide if they are not attached to a hospital? Do radiologists ever work totally separate from hospitals?

 

Thanks

[rmorelan]

Just one starting out resident's thoughts:

 

yeah that is true I think - if you want to work at a big centre, which means most likely a big and popular city then you very likely need a fellowship.

 

There is a decline I think as well in lifestyle as people knew it - income is falling - about 50% of all rads in the US last year saw their income fall under the revisions there. If you are in a hospital you will have certain fixed responsibilities and those will put some limitations on what you can do of course. There is still a great deal of flexibility I think though.

 

In the long term there is concern about the field shifting to a 24/7 model with full staff reading of images at all hours (there is a push for this), and further pressures to read more and more in less and less. How that will play out is not known yet. This is not that much different than any other hospital specialty but the difference is that I guarantee an overnight staff that has to read images to confirm what the resident said in almost real time will no doubt be getting very little sleep every time they are on call. This assumes we don't figure out how to outsource image reading - which has its own huge ramifications. It would be a rather big role shift.

 

There are jobs outside of hospitals as well and some people only do non critical image interpretation and thus don't have same pressures (mammogram interpreters for instance - but there is a lot of basic X-Ray reading as well). The trouble is you won't have access to a CT or MRI scanner outside of a hospital so your range is reduced.

 

This is a bit off topic but I am curious personally as well how all this will play out when we shift to competency based training and recertification of radiologists over time - which the colleges are pushing for. I mean in many fields you may get rare exposure to things but you still get some (ie as a cardiologist running your ward you still get some exposure to all of internal medicine to some degree) but as a radiologist in some places you won't ever see some imaging types as you just don't do work in that area. If you have to retest every 5 years on technology you don't ever use that will be a major pain.

 

IN HOSPITAL JOBS

As far as radiology goes, my understanding is that after a 5 year residency, most graduates require 1-2 fellowships to work staff positions in big city hospitals. I wanted to know if this is true. Also, I have heard of about the declining lifestyle of radiology. Traditionally, it is known to be a lifestyle "ROAD speciality." Is there the option to work as much or as hard as you want when in a hospital? Would I maintain some degree of control?

 

OUT OF HOSPITAL JOBS

I was also wondering if there are any other options for work outside of hospitals as a radiology. For example, I know Anaesthesiology has lots of opportunities to work in outside clinics. In my city, there are some radiologists that have opened outpatient clinics out of the hospitals. How common is this? And what kind of services could a radiologist provide if they are not attached to a hospital? Do radiologists ever work totally separate from hospitals?

 

Thanks

[oldie]

Just one starting out resident's thoughts:

 

yeah that is true I think - if you want to work at a big centre, which means most likely a big and popular city then you very likely need a fellowship.

 

There is a decline I think as well in lifestyle as people knew it - income is falling - about 50% of all rads in the US last year saw their income fall under the revisions there. If you are in a hospital you will have certain fixed responsibilities and those will put some limitations on what you can do of course. There is still a great deal of flexibility I think though.

 

In the long term there is concern about the field shifting to a 24/7 model with full staff reading of images at all hours (there is a push for this), and further pressures to read more and more in less and less. How that will play out is not known yet. This is not that much different than any other hospital specialty but the difference is that I guarantee an overnight staff that has to read images to confirm what the resident said in almost real time will no doubt be getting very little sleep every time they are on call. This assumes we don't figure out how to outsource image reading - which has its own huge ramifications. It would be a rather big role shift.

 

There are jobs outside of hospitals as well and some people only do non critical image interpretation and thus don't have same pressures (mammogram interpreters for instance - but there is a lot of basic X-Ray reading as well). The trouble is you won't have access to a CT or MRI scanner outside of a hospital so your range is reduced.

 

This is a bit off topic but I am curious personally as well how all this will play out when we shift to competency based training and recertification of radiologists over time - which the colleges are pushing for. I mean in many fields you may get rare exposure to things but you still get some (ie as a cardiologist running your ward you still get some exposure to all of internal medicine to some degree) but as a radiologist in some places you won't ever see some imaging types as you just don't do work in that area. If you have to retest every 5 years on technology you don't ever use that will be a major pain.

 

Hey rmorelan,

 

Didn't CMAJ write something about the bolded some time ago? I can't seem to find it anymore but do you see the shift occurring anytime soon?

 

Thanks.

[NLengr]

Hey rmorelan,

 

Didn't CMAJ write something about the bolded some time ago? I can't seem to find it anymore but do you see the shift occurring anytime soon?

 

Thanks.

 

Competency based training is being pushed for all specialties by the college. My specialty has heard possible roll out in 2016. Haven't seen anything official though.

[mavrik13]

Just one starting out resident's thoughts:

 

yeah that is true I think - if you want to work at a big centre, which means most likely a big and popular city then you very likely need a fellowship.

 

There is a decline I think as well in lifestyle as people knew it - income is falling - about 50% of all rads in the US last year saw their income fall under the revisions there. If you are in a hospital you will have certain fixed responsibilities and those will put some limitations on what you can do of course. There is still a great deal of flexibility I think though.

 

In the long term there is concern about the field shifting to a 24/7 model with full staff reading of images at all hours (there is a push for this), and further pressures to read more and more in less and less. How that will play out is not known yet. This is not that much different than any other hospital specialty but the difference is that I guarantee an overnight staff that has to read images to confirm what the resident said in almost real time will no doubt be getting very little sleep every time they are on call. This assumes we don't figure out how to outsource image reading - which has its own huge ramifications. It would be a rather big role shift.

 

There are jobs outside of hospitals as well and some people only do non critical image interpretation and thus don't have same pressures (mammogram interpreters for instance - but there is a lot of basic X-Ray reading as well). The trouble is you won't have access to a CT or MRI scanner outside of a hospital so your range is reduced.

 

This is a bit off topic but I am curious personally as well how all this will play out when we shift to competency based training and recertification of radiologists over time - which the colleges are pushing for. I mean in many fields you may get rare exposure to things but you still get some (ie as a cardiologist running your ward you still get some exposure to all of internal medicine to some degree) but as a radiologist in some places you won't ever see some imaging types as you just don't do work in that area. If you have to retest every 5 years on technology you don't ever use that will be a major pain.

 

With regards to the bolded point - rads income is may be dropping, but they still earn well above what other physicians earn. Often with minimal overhead. Rads fee codes -need- to be cut. Per FTE, they earn close to 600k in Ontario, the highest (essentially tied with Optho) of any specialty. Granted, I've heard from new grad radiologists saying that many people prefer to work 0.8FTE for a better lifestyle, since 1FTE rads is quite busy.

 

See page 151 (pdf 167) for info on FTE equivalent billing in Ontario: http://www.ices.on.ca/file/ICES_PhysiciansReport_2012.pdf

[Lactic Folly]

Per FTE, they earn close to 600k in Ontario, the highest (essentially tied with Optho) of any specialty. [/url]

 

Not quite - keep in mind there have been cuts already. Here, average FTE in Ontario is quoted as 300-400k:

 

http://oraweb.aucc.ca/pls/ua/ua_re3?ADVERTISEMENT_NUMBER_IN=29027

[rmorelan]

With regards to the bolded point - rads income is may be dropping, but they still earn well above what other physicians earn. Often with minimal overhead. Rads fee codes -need- to be cut. Per FTE, they earn close to 600k in Ontario, the highest (essentially tied with Optho) of any specialty. Granted, I've heard from new grad radiologists saying that many people prefer to work 0.8FTE for a better lifestyle, since 1FTE rads is quite busy.

 

See page 151 (pdf 167) for info on FTE equivalent billing in Ontario: http://www.ices.on.ca/file/ICES_PhysiciansReport_2012.pdf

 

I don't disagree about some of the cuts - I think a lot of people are expecting even further declines over time. That is part of the shifts in the field lately (although like Lactic I think that number mentioned is overstating things).

 

(well I should add not all fees as well, that is part of the problem that fee changes are done very bluntly. Somethings are actually quite reasonable, other areas seem to be inflated to me.)

[mavrik13]

Not quite - keep in mind there have been cuts already. Here, average FTE in Ontario is quoted as 300-400k:

 

http://oraweb.aucc.ca/pls/ua/ua_re3?ADVERTISEMENT_NUMBER_IN=29027

 

Compensation for a 45hr/wk U of T academic job is not comparable to 1FTE diagnostic radiology for the rest of the province. The link I posted is for all radiologists in Ontario in 2012 (also includes the spread of billings), compared to your single job posting for an academic position (they can offer below market rate because the job is in Toronto and has research expectations tied to it).

[Zoltar69]

Compensation for a 45hr/wk U of T academic job is not comparable to 1FTE diagnostic radiology for the rest of the province. The link I posted is for all radiologists in Ontario in 2012 (also includes the spread of billings), compared to your single job posting for an academic position (they can offer below market rate because the job is in Toronto and has research expectations tied to it).

 

I have heard a lot of mixed reviews on whether or not I will even be able to get a job after a radiology residency.

[theroadtorads]

I have heard a lot of mixed reviews on whether or not I will even be able to get a job after a radiology residency.

 

After completing 3 rads interviews, this is the impression I got from residents. Some are looking at multiple fellowships to practice in mid-sized cities, unless you want to do mammography. Vancouver and Toronto (and GTA) are saturated, and looks to stay that way for the next few years at least.

 

This may be why there has been a drop-off in applicants in the last 2 years, among other reasons. Apparently this is the least competitive year as far as most staff can remember. But nobody can predict the future.

[Zoltar69]

After completing 3 rads interviews, this is the impression I got from residents. Some are looking at multiple fellowships to practice in mid-sized cities, unless you want to do mammography. Vancouver and Toronto (and GTA) are saturated, and looks to stay that way for the next few years at least.

 

This may be why there has been a drop-off in applicants in the last 2 years, among other reasons. Apparently this is the least competitive year as far as most staff can remember. But nobody can predict the future.

 

That's why I'm questioning why I am even applying to rads at this point.

[theroadtorads]

That's why I'm questioning why I am even applying to rads at this point.

 

Yeah, although I think radiology will still be in demand in the future, some of the comments made by residents are disheartening. I am interviewing for another discipline as well, but didn't think the CaRMs tour would sway my decision this much....

[rmorelan]

Competency based training is being pushed for all specialties by the college. My specialty has heard possible roll out in 2016. Haven't seen anything official though.

 

I heard 2017-2018 over here for rads. Probably a loose target

 

I think some of the job pressures are exactly why there is a bit of a loss of interest in the field. Like many areas radiology will some significant pressures in the years ahead but I still don't think it will be as bad as some other areas.

[Lactic Folly]

Compensation for a 45hr/wk U of T academic job is not comparable to 1FTE diagnostic radiology for the rest of the province. The link I posted is for all radiologists in Ontario in 2012 (also includes the spread of billings), compared to your single job posting for an academic position (they can offer below market rate because the job is in Toronto and has research expectations tied to it).

 

The wording for that posting was "in accordance with the uniform average salary of a Radiologist in the Province of Ontario (approximately $300,000 to $400,000)", which I took as meaning that the estimate was not limited to a single academic practice in Toronto.

 

Here is another recent job posting (full-time with call) for a community practice in northern BC, quoting a similar range:

http://niche.workopolis.com/frontoffice/seekerViewJobDetailAction.do?sitecode=pl517&jobId=1259259&page=search

 

In addition, it appears the ICES report only includes data up to 2009-2010. While I cannot comment on billings in years past, based on my knowledge of current professional fees, I consider the ranges in these job postings more reflective of the present state.

 

What does this mean for those thinking about radiology? Firstly, even for those entering CaRMS, you are at least 5-6 years away from entering practice. Things can change a lot in that time. It remains to be seen how the current year's grads place, but I still haven't met any Canadian grads who truly cannot find employment as a radiologist, given some flexibility with regards to location and job duties. You may not be making significantly more than other specialists, but should be comfortable as you will be involved in the care of numerous patients every day, often those who are most sick or diagnostically challenging, and your words can have a large impact on their management and treatment. Work hard, treat everyone well, think about what special strengths you can bring to a practice while at the same time developing a well-rounded set of skills in all areas, and the odds will shift in your favour...

[StevenB]

Yeah, although I think radiology will still be in demand in the future, some of the comments made by residents are disheartening. I am interviewing for another discipline as well, but didn't think the CaRMs tour would sway my decision this much....

 

Yup, I also applied to rads and another specialty, and have learned a lot about the rads job situation during the CaRMS tour that maybe hadn't sunk in before. Hmm... Some residents have made it sound like a surgical specialty job market, which is scary.

[Lactic Folly]

Understandably it's quite stressful for residents to be graduating without jobs lined up, and this may be reflected in the comments you are hearing. Though to my knowledge, we're not at the point of multiple fellowships for community positions...

[MansionMD]

Yeah, although I think radiology will still be in demand in the future, some of the comments made by residents are disheartening. I am interviewing for another discipline as well, but didn't think the CaRMs tour would sway my decision this much....

 

what other specialty are you interviewing for?

[rmorelan]

Understandably it's quite stressful for residents to be graduating without jobs lined up, and this may be reflected in the comments you are hearing. Though to my knowledge, we're not at the point of multiple fellowships for community positions...

 

a lot of stress on getting fellowships as well - I know some senior residents who didn't get one this year (that happens) from multiple schools that now are extra worried a) they don't have job lined up and they don't think without a fellowship they will become competitive down the line.

[Lactic Folly]

The thing about fellowships is that the application process takes place quite early (summer between PGY 3-4, ~three years before starting practice), making it difficult to target specific positions through one's choice of subspecialty. If one's fellowship is not in demand as one prepares to enter the job market, it could be that further training is needed to meet the needs of whichever group is hiring. At the same time, one will need to somehow maintain general skills, as most positions outside of subspecialized academics will want people to read all modalities/areas - thus doing some locums after residency is not necessarily a bad idea. If one does not have a fellowship lined up early on, often positions open up closer to the anticipated start date. I also know a few people who graduated within the last 1-2 years who have gone straight into practice from residency without fellowship. There remains the option to reenter training at a later date.

[Ian Wong]

I think the jobs will be out there. Yes, you are going to need a fellowship to be competitive in a large city, but most residency/fellowship grads do find jobs. No, you probably won't get all three of the holy trinity of jobs (money, location, and lifestyle), but you probably wouldn't get this in any other medical specialty either.

 

Getting a radiology fellowship is not difficult, particularly if you are willing to do it in the US, where Canadian grads tend to be held in high esteem. Canadian radiology residents are usually considered extremely well trained, and many top-tier US fellowship programs are thrilled to take a Canadian grad as a fellow.

 

As far as salary goes, who knows where that will be in the future? I try not to worry about that. As any radiology resident or staff will tell you, imaging volumes have gone through the roof in the last decade. We are doing more studies, working longer daytime hours, and taking significantly more volume of call.

 

We are critical to patient care and patient flow in a hospital. Want to piss off the clinicians? Don't answer the phone in the CT reading room for an hour or two, and watch them all come to the department to find you.

 

As far as job search, we still have it better than most physicians because you can be more mobile. Once you've built up a practise as a surgeon, you are unlikely to be able to leave, even if a better opportunity comes up. In radiology, you are likely to be hospital-based, which means you aren't tied down to an office or a particular pool of patients, and can easily move on to a better job.

 

Competency-based recertification is on its way, and likely will involve reporting the numbers of each modality performed each year. I would assume that if you join a new group that requires you to read something that you haven't done in the last several years, you may be asked to prove competency somehow, or undergo some sort of audited re-training. I think it will be really difficult to institute logistically.

 

Are you safe to read MRI if you only read 1 brain MRI a year? How about 50 brain MRI's? What about 500 brain MRI's? What about if you read a lot of brain MRI's, but not a lot of sella, orbit, or IAC MRI's? etc, etc. More importantly, what if you read a high volume of cases, but read them all badly?

 

And yes, there are private radiology clinics out there, which are not affiliated with hospitals. They come in all flavours, and their scope depends on the individual province. Some clinics are able to run CT and MRI in addition to the more basic modalities like plain film and ultrasound. Some charge patients privately. Others limit their work to third party payors like Workers Comp, disability insurance companies, RCMP, etc. Others take all comers and bill the government per case (they would be restricted to billing the standard provincial rate, and cannot charge the patient extra). A huge advantage to these clinics is that hours are controllable, and you would have no call. However, these clinics tend not to have the acute cases seen in the hospital, and if you did outpatient only work for a few years, you will definitely lose all sorts of inpatient skills, including most IR, trauma, acute post-op complications, etc.

 

Many groups that are large enough to run private clinics also have hospital contracts and do hospital work as well. In those blended practises, you would have a great mix of work in an average week, including lighter clinic days with controllable hours, and then a typically more frantic pace in the hospital.

 

As I mentioned earlier, I think radiology is still a wonderful specialty. I really like my day to day job. Wouldn't trade it for any other specialty.

 

Ian